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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 50. This is the beginning of the thread.
Posted by morgan miller on November 6, 2010, at 22:19:58
A member of Mind and Muscle just gave all the evidence he needed to convince himself(and likely others) that Escitalopram(Lexapro in the U.S.) is most likely to be effect with the least amount of side effects and all the SSRIs, including Citalopram. He makes a pretty good argument. Here's the thread,
http://www.mindandmuscle.net/forum/index.php?showtopic=43538
Posted by ed_uk2010 on November 7, 2010, at 3:12:39
In reply to One person's argument for Escitalopram, posted by morgan miller on November 6, 2010, at 22:19:58
He should work for Lundbeck (!)
Posted by Alexanderfromdenmark on November 7, 2010, at 4:55:31
In reply to One person's argument for Escitalopram, posted by morgan miller on November 6, 2010, at 22:19:58
Escitalopram ruined my life.
Posted by rculater on November 7, 2010, at 6:54:04
In reply to Re: One person's argument for Escitalopram, posted by Alexanderfromdenmark on November 7, 2010, at 4:55:31
> Escitalopram ruined my life.
What happened Alex ?
Posted by linkadge on November 7, 2010, at 7:12:27
In reply to Re: One person's argument for Escitalopram, posted by Alexanderfromdenmark on November 7, 2010, at 4:55:31
Of course, you're going to expect me to make some criticisms, so here goes:
First of all, his initial statement "but they're highly effective" is highly flawed. Large scale, placebo controlled meta analysis simply do not support the notion that SSRIs are "highly effective" in the general depressed population.
1) The first study's researchers have financial ties to Lundbeck. Also, no placebo analysis.
2) The second study's researchers have financial ties to Lundbeck. No placebo analysis.
3) The third study (IMHO) is a bit misleading. The total change in MADRS score was similar between paroxetine and escitalopram. Sure, there may have been some subgroup advanatages for escitalopram, but because the total MADRS scores were similar, there must have been some (unmentioned) subgroup advantages for paroxetine as well. Also, no placebo analysis.
4) I'm skeptical of this study because I have not seen the whole study. What doses of medications were used? Also, the study is meaningless because there was apparently no rating scale for "improvement". The outcome just says a certain number of patients experienced "improvement". I would think there would be a tendancy to report an "improvement" (regardless of how small or insignificant) to please researchers. It also appears that this is a proof of concept study (i.e. no placebo arm) again, meaningless.
What about the meta analysis which show that escitalopam is *not* infact superior to citalopram?
http://www.ncbi.nlm.nih.gov/pubmed/14665791
Also keep in mind that a *lot* of escitalopram studies have been funded by Lundbeck. I think there may be some advantages of escitalopram in terms of side effects and that is why the placebo analysis is so important. It could be that escitalopram is performing as well as the placebo (due to fewer side effects) yet other treatments are performing worse. Escitalopram is just the new kid on the block.
Linkadge
Posted by ggggg123 on November 7, 2010, at 9:25:36
In reply to Re: One person's argument for Escitalopram, posted by Alexanderfromdenmark on November 7, 2010, at 4:55:31
same here Alexander! well mostly citalopram, what meds are you taking? I have read your story on another website, it is almost identical to mine, but I'm pretty sure recovery is possible. I feel like I've covered alot of ground lately. People don't understand the negative impact of raising just serotonin! its not good it can screw your body up!!!
Posted by Phillipa on November 7, 2010, at 9:50:51
In reply to Re: One person's argument for Escitalopram » Alexanderfromdenmark, posted by ggggg123 on November 7, 2010, at 9:25:36
I felt myself no caring on a low dose and that was bothersome so stopped it. Seems low doses are in favor now even with pdocs. Phillipa
Posted by ggggg123 on November 7, 2010, at 11:29:43
In reply to Re: One person's argument for Escitalopram, posted by Phillipa on November 7, 2010, at 9:50:51
I have been drug free for many months, I have post citalopram and escitalopram problems, My only hope is that norep and dop drugs eventually pull me out of this nightmare. Alexander is the same, we have post ssri problems, ssri's are a joke, they should be banned!!! I took them for about 6 months, I know some people say it can take years to recover from them, well at least theres hope. My experience is you don't think emotionally, you don't think much at all, you become a zombie. Frontal lobe activity is reduced, thus one develops frontal lobe syndrome, might aswell have a lobotomy!!! raising one neurotransmitter beyond normal levels and disregarding norep and dop is dangerous. Especially for people with severe depression as we need all the norepinephrine and dopamine we can get.
Posted by ed_uk2010 on November 7, 2010, at 15:50:08
In reply to Re: One person's argument for Escitalopram, posted by ggggg123 on November 7, 2010, at 11:29:43
>raising one neurotransmitter beyond normal levels and disregarding norep and dop is dangerous. Especially for people with severe depression as we need all the norepinephrine and dopamine we can get.
All psych drugs have the potential to f*ck people up, there is nothing unique about SSRIs here. If you think that drugs acting on other neurotransmitters don't have the potential to cause serious harm, think again.
Posted by ggggg123 on November 7, 2010, at 18:48:12
In reply to Re: One person's argument for Escitalopram » ggggg123, posted by ed_uk2010 on November 7, 2010, at 15:50:08
I don't see many people complaining about any other drugs apart from the ssri's, I have taken 3 ssri's, an ndri, an maoi inhibitor,a beta blocker, an snri, Trazodone, the novel mirtazapine, amitriptyline, buspirone, dopamine agonist, phenytoin, hydroxyzine, levodopa, amantadine, cyproheptadine and many many more drugs and 10's of different herbs and vits. Of course the anti pyschotics can have a bad effect on you and so can all drugs, but the ssri's have a bad effect on you when they are working properly not just afterwards. They make you feel like a zombie. Look at all the post ssri apathy and ssri apathy complaints, now match that with complaints about other ad's. AD's are supposed to make you feel better not worse, so in response to your comment, I would say if an ad makes you feel worse whilst on the drug and afterwards, then the ad was completely ineffective.
Also I never said that other ad's aren't flawed, of course they are. my point is that ssri's are flawed when working correctly, if you understood about the apathy they cause you would know what I mean.
it is not a requisite that ad's negatively affect your neurotransmitters (maybe slight downregulation, but increased processing).
Its very distressing for people suffering post ssri apathy, very very distressing.
The only known effects on neurotransmitter functioning is that agonists downregulate and antagonist upregulate, this often takes many years of heavy use, and is often not reflected by states of mind, as it is more neurotransmitter proccessing that is implicated in depression rather than number of receptors.
Posted by Tomatheus on November 7, 2010, at 19:46:45
In reply to Re: One person's argument for Escitalopram » ed_uk2010, posted by ggggg123 on November 7, 2010, at 18:48:12
ggggg123,
Call me the exception to your rule, but I never felt like a zombie on any of the SSRIs that I took. Unfortunately, the story is different when it comes to antipsychotics. Saying that a medication will do this or do that is only so helpful in my opinion because it fails to take into consideration the wide range of responses that different individuals can have to the same medication. I'm not saying that there isn't any truth to the reports that we hear of people experiencing side effects like apathy and anhedonia on SSRIs, but to assume that *everybody* who takes an SSRI experiences these side effects because a few people on the Internet do seems to be a bit shortsighted and misguided.
Tomatheus
Posted by morgan miller on November 7, 2010, at 21:31:57
In reply to Re: One person's argument for Escitalopram, posted by ggggg123 on November 7, 2010, at 11:29:43
> I have been drug free for many months, I have post citalopram and escitalopram problems, My only hope is that norep and dop drugs eventually pull me out of this nightmare. Alexander is the same, we have post ssri problems, ssri's are a joke, they should be banned!!! I took them for about 6 months, I know some people say it can take years to recover from them, well at least theres hope. My experience is you don't think emotionally, you don't think much at all, you become a zombie. Frontal lobe activity is reduced, thus one develops frontal lobe syndrome, might aswell have a lobotomy!!! raising one neurotransmitter beyond normal levels and disregarding norep and dop is dangerous. Especially for people with severe depression as we need all the norepinephrine and dopamine we can get.
Obviously everyone is different. I'm sorry you had such a bad experience with SSRIs. There are many people though that have done very very well on SSRIs and stay on them for a very long time. There is no perfect drug, not yet at least. Until there is, we will have to take risks and hope that drugs don't mess with us the way the did with you.
Posted by morgan miller on November 7, 2010, at 21:37:45
In reply to Re: One person's argument for Escitalopram, posted by linkadge on November 7, 2010, at 7:12:27
You definitely make good arguments here and I totally understand your skepticism. I just thought he presented some decent evidence. I personally am not sure where I stand on this issue. I do think that lexapro may have been better than celexa, but I was not on either long enough to make a good evaluation.
For me the best SSRI was Zoloft. I slept great and felt pretty darn good. The only problem was that I was a bit on the manic side much of the time. I know what it did to you. It's crazy how a drug can affect 2 people in such different ways.
Posted by g_g_g_unit on November 8, 2010, at 2:15:25
In reply to Re: One person's argument for Escitalopram » linkadge, posted by morgan miller on November 7, 2010, at 21:37:45
Is it possible that those who respond poorly (or feel 'zombified') to SSRIs might also have an underlying condition like inattentive ADD? While undiagnosed, I felt like a complete non-entity on SSRIs, but then again, I've always had to fight to motivate myself and concentrate, so SSRIs just made the battle that much harder.
Maybe people with normal executive function aren't hit as hard? Just uneducated speculation .. feel free to correct me.
Posted by ggggg123 on November 8, 2010, at 6:18:28
In reply to Re: One person's argument for Escitalopram » ggggg123, posted by Tomatheus on November 7, 2010, at 19:46:45
ye I don't assume everybody will get them, but there is a risk. obviously some people must have a great time on ssri's, its all my opinion, you don't have to read it, read what doctor bob wrote ate the top of the page, I have an unwritten dislaimer, If it helps I will keep writing this is my truth, my opinion, at the end and that it is not the same for everybody. But one of the commmon side effects of ssri's is emotional blunting (apathy). My Theory is that the severely clinically depressed will not respond well to ssri's and may do better on a multi system targeting ad. I'm glad to hear you had a good outcome and response, if only we all could have.
Posted by ggggg123 on November 8, 2010, at 6:26:50
In reply to Re: SSRI's and underlying conditions, posted by g_g_g_unit on November 8, 2010, at 2:15:25
ye I agree, I have always had add problems, but never extreme, do you think the ssri's played a part in your retarded depression? lol what you say might hold some truth, which means a percentage of people are susceptible to anhedonia whilst taking ssris, but if the dose was high enough, surely anybody would experience anhedonia on an ssri? post ssri anhedonia, is obviously more rare and maybe we have some sort of genetic predisposition. SSRI anhedonia is so widely accepted and acknowledged, psychs say that it is part of the ssri's therapeutic effect, they blunt your emotions reducing anxiety and emotional turmoil.
Posted by g_g_g_unit on November 8, 2010, at 7:03:27
In reply to Re: SSRI's and underlying conditions » g_g_g_unit, posted by ggggg123 on November 8, 2010, at 6:26:50
Well, like I say, my case is unique in that I have *never* known what it's like to be able to freely direct myself towards extrinsically rewarding tasks. I would watch roommates and so forth pour through whole books in a day in utter bafflement (I would take months at a time to finish books).
I think SSRIs blunted my ability to pursue pleasurable activities (where I could naturally concentrate easier), so I was always just kind of left in this weird fog.
I spent forever demonizing them, but there's no way they're responsible for my depression (I never stayed on any long enough to suffer any discontinuation effects). I guess they just work better as a temporary adjunct for people who were able to function normally prior to depression, and don't have some chronic condition like ADD or OCD. I wish I was part of that population.
> ye I agree, I have always had add problems, but never extreme, do you think the ssri's played a part in your retarded depression? lol what you say might hold some truth, which means a percentage of people are susceptible to anhedonia whilst taking ssris, but if the dose was high enough, surely anybody would experience anhedonia on an ssri? post ssri anhedonia, is obviously more rare and maybe we have some sort of genetic predisposition. SSRI anhedonia is so widely accepted and acknowledged, psychs say that it is part of the ssri's therapeutic effect, they blunt your emotions reducing anxiety and emotional turmoil.
Posted by ggggg123 on November 8, 2010, at 7:23:45
In reply to Re: SSRI's and underlying conditions » ggggg123, posted by g_g_g_unit on November 8, 2010, at 7:03:27
Personally I think over analysing our condition isn't helpful. Getting treatment and moving on with our lives is undoubtedly the best option. This site isn't great for recovery, getting out and enjoying life is. My advice to you is the same as for myself, I would say get on an add med, maybe supplement it with an nri and go get your life back. Retarded depression is no joke, its almost like being the living dead. In my case ssri's helped induce it, probably though attenuation, but it doesn't matter its a chemical imbalance, it must be fixed and life must resume.
Posted by Tomatheus on November 8, 2010, at 7:39:58
In reply to Re: One person's argument for Escitalopram » Tomatheus, posted by ggggg123 on November 8, 2010, at 6:18:28
ggggg123,
My response to SSRIs was hardly a good one. I experienced rapid cycling on Paxil and Prozac and felt significantly more depressed than usual on Zoloft. The point that I was trying to make was that even though I never responded consistently to any SSRI, I did not experience any apathy, anhedonia, or zombie-like effects on the medications. Just because a person did not experience those side effects from SSRIs does not mean that their response was necessarily good.
Although I do not agree that nobody with severe clinical depression will respond favorably to an SSRI, I think that you have the right idea in stating that those with severe clinical depression tend to respond best to medications that target multiple neurotransmitters. I know that personally the only antidepressant that successfully treated my anergic depression (which used to be very severe and probably still would be if it weren't for all of my treatments) for more than a few days was Nardil. From what I understand, it is not unheard of for patients to go through one reuptake inhibitor after another with no success only to find success with an MAOI. Additionally, one review article that examined the effectiveness of the RIMA moclobemide found that moclobemide was as effective as the SSRIs, but less effective than the MAOIs Nardil and Parnate, which would seem to suggest that Nardil and Parnate are generally more effective than SSRIs.
I appreciate the time that you take to write your posts, and although I don't agree with everything that you write, I do think that you put forth some intriguing ideas and should continue to do so. I look forward to reading more of your posts.
Tomatheus
Posted by g_g_g_unit on November 8, 2010, at 7:42:49
In reply to Re: SSRI's and underlying conditions » g_g_g_unit, posted by ggggg123 on November 8, 2010, at 7:23:45
Well sure. There are times when being here is really helpful for me, and other times when it's detrimental. I would never want to speak on behalf of other posters, but it definitely gets easy to lock myself in a kind of pathological hopelessness when I spend too much time reading posts here. Sometimes just spending a few days away from the internet can be helpful. The problem is that I've spent so long like this (relatively speaking) that I'm not sure what the h*ll is left for me in life anyway. It's like stockholm syndrome.
> Personally I think over analysing our condition isn't helpful. Getting treatment and moving on with our lives is undoubtedly the best option. This site isn't great for recovery, getting out and enjoying life is. My advice to you is the same as for myself, I would say get on an add med, maybe supplement it with an nri and go get your life back. Retarded depression is no joke, its almost like being the living dead. In my case ssri's helped induce it, probably though attenuation, but it doesn't matter its a chemical imbalance, it must be fixed and life must resume.
Posted by ed_uk2010 on November 8, 2010, at 13:41:58
In reply to Re: One person's argument for Escitalopram » ed_uk2010, posted by ggggg123 on November 7, 2010, at 18:48:12
>I don't see many people complaining about any other drugs apart from the SSRIs.
Other meds can also cause many adverse effects. You will always read more complaints about drugs which are prescribed more frequently.....and SSRIs are prescribed much more frequently than most other psych drugs.
Posted by ed_uk2010 on November 8, 2010, at 13:46:54
In reply to Re: One person's argument for Escitalopram » ggggg123, posted by Tomatheus on November 7, 2010, at 19:46:45
>Call me the exception to your rule, but I never felt like a zombie on any of the SSRIs that I took.
Overall, SSRIs are better tolerated than tricyclic antidepressants. They are also better tolerated than venlafaxine.
As far as emotional numbing is concerned, venlafaxine was no better for me than SSRIs. Venlafaxine can certainly cause emotional numbness.
Posted by morgan miller on November 8, 2010, at 20:42:04
In reply to Re: One person's argument for Escitalopram » ggggg123, posted by ed_uk2010 on November 8, 2010, at 13:41:58
> >I don't see many people complaining about any other drugs apart from the SSRIs.
>
> Other meds can also cause many adverse effects. You will always read more complaints about drugs which are prescribed more frequently.....and SSRIs are prescribed much more frequently than most other psych drugs.
>My thoughts exactly.
Posted by emmanuel98 on November 8, 2010, at 20:46:41
In reply to Re: One person's argument for Escitalopram » ggggg123, posted by Tomatheus on November 8, 2010, at 7:39:58
That's my experience too. SSRIs (and SNRIs) didn't hurt but they didn't help either, especially when I became severely depressed and suicidal. Parnate worked for me and still does. Not everyone is treatment resistant. Lots of people benefit from some kind of AD or AP. I think you here mostly negative experiences on this site, because people on this site are still seeking something that works for them.
>
> My response to SSRIs was hardly a good one. I experienced rapid cycling on Paxil and Prozac and felt significantly more depressed than usual on Zoloft. The point that I was trying to make was that even though I never responded consistently to any SSRI, I did not experience any apathy, anhedonia, or zombie-like effects on the medications. Just because a person did not experience those side effects from SSRIs does not mean that their response was necessarily good.
>
> Although I do not agree that nobody with severe clinical depression will respond favorably to an SSRI, I think that you have the right idea in stating that those with severe clinical depression tend to respond best to medications that target multiple neurotransmitters. I know that personally the only antidepressant that successfully treated my anergic depression (which used to be very severe and probably still would be if it weren't for all of my treatments) for more than a few days was Nardil. From what I understand, it is not unheard of for patients to go through one reuptake inhibitor after another with no success only to find success with an MAOI. Additionally, one review article that examined the effectiveness of the RIMA moclobemide found that moclobemide was as effective as the SSRIs, but less effective than the MAOIs Nardil and Parnate, which would seem to suggest that Nardil and Parnate are generally more effective than SSRIs.
>
> I appreciate the time that you take to write your posts, and although I don't agree with everything that you write, I do think that you put forth some intriguing ideas and should continue to do so. I look forward to reading more of your posts.
>
> Tomatheus
Posted by linkadge on November 9, 2010, at 6:14:44
In reply to Re: One person's argument for Escitalopram, posted by emmanuel98 on November 8, 2010, at 20:46:41
I have friends who failed every ssri and then respond to something like St. John's Wort.
Tell me this, zoloft is supposedly a "first line treatment" for depression. In head to head trials it performed a little worse than SJW. Why is SJW not a first line depression treatment then?
Linkadge
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